Looking for Dr. Right

With more and more websites rating physicians, the question is: Can you trust them?

It used to be that picking a good internist or a skilled surgeon was relatively straightforward: You'd call friends for recommendations, or ask relatives over a holiday dinner. Now, with the explosion of websites rating doctors over the past several years, the options for researching individual physicians are dizzying.

More than 40 Internet sites allow patients to rate their doctors based on their personal experiences, both good and bad, including RateMDs.com, DrScore.com and now, Angie's List, at www.angieslist.com. There also are dozens of town- and city-specific online communities, mostly for parents, where members regularly discuss their doctors and pediatricians.

Speaking to the growing attraction of consumer reviews, Angie's List, a respected source for ratings of plumbers, painters, and general contractors since 1995, added healthcare providers last year and has seen ratings of these professionals soar.

The company collects 40,000 reports from members every month, and 25 percent of these are now on doctors and other medical providers. "There's been a societal shift - consumers are going online to have a lot of the conversations they used to have over the back fence," said company founder Angie Hicks.

On top of these subjective ratings, several organizations and state agencies provide information on doctors' education, whether they've been disciplined for inappropriate behavior or poor care, if their office staff treats patients well, and, for surgeons, how much experience they have doing specific operations.

The question, though, "is what is reliable information?" said Dr. Mario Motta, a cardiologist in Salem and president of the Massachusetts Medical Society. "What separates the wheat from the chaff on the Internet?"

Some websites, like RateMDs.com, don't even verify that the poster is actually a patient of the doctor they're rating, so a searing report could have been written by an angry neighbor and a glowing report, by the doctor's mother. Because of this, the site itself advises readers to "always take these ratings with a grain of salt."

When looking for a physician, many doctors and other healthcare experts said the best place to start is still with family and friends - and ask other doctors. Insurance companies also keep lists of doctors who are accepting new patients, as do most hospitals, if you want to have surgery at a particular institution.

"To a certain extent it's like blind dating," said Dr. Thomas Lee, a cardiologist at Brigham and Women's Hospital. "How are you going to find someone you feel good about and really click with? Word of mouth referrals from friends and neighbors and doctors mean something."

Then, turn to online tools.

The first agency in the state - and the country - to provide online profiles of doctors was the Massachusetts Board of Registration in Medicine. You can search for a doctor's profile at www.massmedboard.org. The profiles list about 20 pieces of information, including where a doctor attended medical school, what type of insurance he or she accepts, and any criminal convictions or disciplinary actions by a hospital or the board itself. Obviously a checkered past is a red flag.

One caution in using this information: It can take years for hospitals and agencies to take action against a doctor, so a profile may not reflect an ongoing investigation. Also, the state updates profiles every two years, so a doctor's practice may be listed as open to new patients when it's actually closed. And some information may never become public, such as when a doctor has a substance abuse problem.

One of the most useful bits of information in the profiles is whether a doctor is board certified. Doctors who have been certified by the American Board of Medical Specialties have passed a written test and met minimum training requirements, one important consideration when picking a doctor.

For surgeons, the state lists through hcqcc.hcf.state.ma.us the number of operations individual doctors have done and, for heart bypass surgery, the website includes mortality rates, although the data are several years old. While the research is not clear-cut, a number of studies have linked higher patient volume for certain procedures to better results because surgeons who do more operations have more practice.

Massachusetts Health Quality Partners, www.MHQP.org, ranks physician offices - though not individual doctors - with one to five stars based on how well they prevent and treat a variety of illnesses including asthma, depression, heart disease, diabetes, and high cholesterol. The organization, widely respected for the thoroughness of its data, also surveyed 70,000 patients and parents of pediatric patients about how well the doctors in a particular office know their patients and whether the office provides timely appointments.

Despite the effort that goes into these data-driven websites, Deborah Wachenheim, of the consumer advocacy group Health Care for All, said research shows that most people don't use them - either because they don't know they exist or because they don't provide the information people want. Information like "do they know what they're doing and are they going to be accessible when I need to reach them in a crisis?," Lee added.

The growing number of websites allowing patients to simply express their opinions are trying to fill this void - a trend that irritates many doctors.

Hicks said Angie's List requires posters to identify themselves and also identifies them to the doctor they're reporting on - though other consumers can't see posters' names. Members rate their physicians on availability, punctuality, bedside manner, and effectiveness of treatment and also post comments. One popular Boston physician, Dr. Martin Solomon, has an overall "A" rating based on reports from six patients, whose comments included "he's the best diagnostician I know" though "he is not that very prompt."

Solomon doesn't take issue with the comment - he knows he can run late. But he said that while websites such as Angie's List can be helpful, the shortage of primary care doctors means that patients often can't be that choosy and must see whomever is taking new patients. His practice, for example, is full, as are those of many of the highest rated doctors.

Computer programs check for posters trying to "game the system," Hicks said, such as reports on many different doctors from the same home - or lots of reports on one doctor from a computer in the doctor's office.

Susan Shapiro, 58, of Wayland, joined Angie's List two months ago to research appliance repair experts. When the company made an appeal for members to rate their doctors, she didn't hesitate. "I have two doctors who are exceptional, so I felt they deserved that kind of recognition," she said, but added, "if I had someone who was really rude, incompetent or a danger, I would have done that too."

Some physicians, however, say these sites don't have enough opinions to make them reliable. One Somerville doctor on Angie's List is rated with a "C" based on a report from one patient who commented that "she has become less adept at listening."

That, said Shane Stadler of Medical Justice, a North Carolina company founded by a neurosurgeon, could be an aberration or someone who tends to be negative about most things. There's no way for consumers to know, he said. His company sells a product to doctors that includes a contract they can require patients to sign, promising that the patient won't post comments about the doctor on the Internet. While companies like RateMDs.com tell disgruntled doctors "you can reply to any or all of your ratings," Stadler said patient confidentiality laws prevent doctors from doing so.

In the end, Motta said, the most important factor in choosing a doctor cannot be discerned over the Internet. It's "chemistry," he said. "Some patients want the facts and nothing but the facts. Other patients need a lot more hand-holding. Often you don't know until the visit."